North West Ipswich Big Local Trust

1

North West Ipswich Big Local Trust

Application for Support

The North West Ipswich Big Local Trust welcomes partnership working. We want to work with organisations across the area to enable the community of Whitton, Whitehouse and Castle Hill to thrive and be a beacon of commuinty resilliance and opportunity.
Funding support and a partnership appraoch is one way of achieving this aspiration.
About Your Organisation
Contact Name: / Organisation Name:
Position:
Address:
Postcode: / Email Address:
Website:
Telephone Number:

1. What is the legal status of your organisation?Please tick below

Unincorporated Association (a group with a set of rules)
Charity Company Limited by Guarantee (please provide us with your company registration number):
Local branch of a National Organisation
Social Enterprise
Registered Charity/CIO/Trust (please provide us with your registration number):

1. Please tell us about your organisation:

Charity Number (if applicable):
Company Number (if applicable):
When did your organisation start? Month: Year:
How many people are on your organisations Governing Body or Board of Directors?
Are you a branch of a larger organisation? Yes: No:
Please provide a summary from your most recent accounts:
Are the figures given

• Information from your most recent accounts approved by your organisation?
  

Or

• A projection because your organisation has been running for less than 15 months?

Account year ending:

Total income for the year (A)

Total expenditure for the year (B)

Surplus or deficit for the year (A-B)

Total savings or reserves at the year end
Is this the first time your organisation has applied for funding from NWI BLT? Yes / No
Please give details:
About the Project/Activity
2.1Project details
Project Title:
Project site address:
Please give comprehensive details of your project. (aims / values and activities) (Maximum 300 words):
Have you read and understood the North West Ipswich Big Local plans and aims? Yes / No
Please explain how your project help NWIBLT achieve their aims?
2.2 Benefits:
What are the benefits of this project:
Who benefits from this project:
How many people will benefit from this project:
Directly (on the project): / Indirectly ( family, friends and wider community):
Are they mainly in the NWI BLT designated are? Yes / No
Who in your organisation will be involved in this project: Please give details:
Name:
Role:
Email:
Contact number:
When will your project take place?
Start DateEnd Date
Is your start date
Fixed Flexible
2.3 Monitoring and Evaluation:
Please note your organisation will be required to complete NWI BLT monitoring and Evaluation forms.
We will require the following information from you at the end of your project. Please read through and be sure that you will be able to provide us with this detail.
•Total numbers engaged with across Whitton, Whitehouse and Castle Hill.
•Total numbers engaged with in our ‘pink area’ – map and road names available on website.
•Impact made. Photos, case studies and testimonials.
•Breakdown of how the money was spent.
How will you measure the success of your project and its impact on the North West Ipswich Community?
We are keen to support projects that can demonstrate a level of sustainability after this funding has been spent. You might also like to indicate if your project will leave behind any form of legacy. Please describe the measures you will take to ensure that your project will be able to continue and any legacy left behind.
Project Costs:
How much will each item or activity cost and how much are you applying for from NW Ipswich Big Local Trust?
Activity /

1. Total Cost

/

1. Amount requested from BLT**

Total / £ / £
** PLEASE INDICATE THE TOTAL AMOUNT OF FUNDING REQUESTED FROM NW IPSWICH BIG LOCAL TRUST:______
A)BETWEEN £501 - £5,000

B)BETWEEN £5,001 - £10,000
Please note:
There is a 5%match funding requirement for projects seeking between £5,001 - £10,000 – see guidance for further information
How much funding has been secured towards the overall cost of the project and where has it come from?

NONE SECURED
£...... FROM:
£……………...TOTAL SECURED
Have you applied for any funding from other sources on which a decision is pending and if so, how much and where from?

NOYES
£...... FROM:
£……………...TOTAL ON DECISION PENDING

For office use only

Amount Requested
Application Reference Number
Checklist Complete
Notes
Reviewing Officer
Support Accepted / Support Declined / Further Information

T&F group V1. May 2017